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Li Y, Wu G, Liu J, Zhang Y, Yang W, Wang X, Duan L, Niu L, Chen J, Zhou W, Han W, Wang J, Zhong H, Ji G, Fan D, Hong L. Log odds of positive lymph nodes as a novel prognostic predictor for gastric cancer: a systematic review and meta-analysis. BMC Cancer 2023; 23:523. [PMID: 37291493 DOI: 10.1186/s12885-023-10805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 04/03/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to summarize the predictive and prognostic ability of the log odds of positive lymph nodes (LODDS) staging system and compare it with pathological N (pN) classification and the ratio-based lymph node system (rN) for the overall survival (OS) of gastric cancer (GC). METHODS Through a systematic review till March 7, 2022, we identified population-based studies that reported the prognostic effects of LODDS in patients with GC. We compare the predictive effectiveness of the LODDS staging system with that of the rN and pN classification systems for the OS of GC. RESULTS Twelve studies comprising 20,312 patients were included in this systematic review and meta-analysis. The results showed that LODDS1, LODDS2, LODDS3, and LODDS4 in GC patients were correlated with poor OS compared with LODDS0 (LODDS1 vs. LODDS0: HR = 1.62, 95% CI (1.42, 1.85); LODDS2 vs. LODDS0: HR = 2.47, 95% CI (2.02, 3.03); LODDS3 vs. LODDS0: HR = 3.15, 95% CI (2.50, 3.97); LODDS4 vs. LODDS0: HR = 4.55, 95% CI (3.29, 6.29)). Additionally, significant differences in survival were observed among patients with different LODDS classifications (all P-values were < 0.001) with the same rN and pN classifications. Meanwhile, for patients with different pN or rN classifications with the same LODDS classification, prognosis was highly similar. CONCLUSION The findings show that LODDS is correlated with the prognosis of GC patients and is superior to the pN and rN classifications for prognostic assessment.
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Affiliation(s)
- Yiding Li
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Guiling Wu
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Jinqiang Liu
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Yujie Zhang
- Department of Histology and Embryology, School of Basic Medicine, Xi'an Medical University, Xi'an, 710021, China
| | - Wanli Yang
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Xiaoqian Wang
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Lili Duan
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Liaoran Niu
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Junfeng Chen
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Wei Zhou
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Weili Han
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Jing Wang
- Department of Immunology, Fourth Military Medical University, Xi'an, 710032, China
| | - Helun Zhong
- Treatment Centre for Traumatic Injures, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Gang Ji
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Daiming Fan
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Liu Hong
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China.
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Wang YN, Chang SY, Hwang JM, Chang YK, Kao WY, Wan HL, Tzeng IS, Wu CC. Evaluating the benefit of adjuvant radiotherapy after extensive lymph node dissection for gastric cancer: a single-institute retrospective study. Tzu Chi Med J 2021; 33:288-293. [PMID: 34386368 PMCID: PMC8323656 DOI: 10.4103/tcmj.tcmj_230_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/06/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to evaluate whether adjuvant radiotherapy (RT) can improve the treatment outcome of patients with locally advanced gastric cancer who underwent extensive lymph node dissection (ELND). Materials and Methods: This retrospective study included patients with gastric cancer pathological stages IIA–IIIC at Taipei Tzu Chi Hospital between 2008 and 2015. Patients (a) aged >80 years, (b) with distant metastasis at diagnosis, (c) with coexisting malignancies, (d) who did not complete the prescribed RT course, and (e) who died 1 month after surgery were excluded. Among 420 patients diagnosed with gastric cancer, 98 were included. Results: The median follow-up was 24.5 months. Of 39 patients who underwent adjuvant RT, 38 also received adjuvant chemotherapy (CT). Of 59 patients who did not receive adjuvant RT, only 34 received adjuvant CT. ELND was performed in 67.3% of the patients. The 5-year overall survival (OS) rate was 40%. In the univariate analyses, adjuvant CT regimen, 5-fluorouracil + leucovorin, was associated with worst outcome, while TS-1 was associated with better survival outcome (P = 0.018). The number of involved lymph nodes was strongly related to the OS and disease-free survival (DFS) (P < 0.001). We tried using different numbers of involved lymph nodes as a cutoff point and found that adjuvant RT significantly improved both OS and DFS in patients whose involved lymph nodes were ≥4 (OS, P = 0.017; DFS, P = 0.015). In multivariate analyses, better DFS was associated with negative surgical margin (P = 0.04), earlier disease stage (P = 0.001), adjuvant radiotherapy (P = 0.045), and adjuvant CT regimen TS-1 (P = 0.001). Conclusion: Adjuvant RT could improve DFS of patients with locally advanced gastric cancer with or without ELND. When the number of involved lymph nodes is ≥4, adjuvant RT is strongly suggested.
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Affiliation(s)
- Yu-Nong Wang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Shou-Yi Chang
- Department of Hematology/Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Jing-Min Hwang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Radiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - You-Kang Chang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Radiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Woei-Yau Kao
- Department of Hematology/Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Oncology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsiang-Lin Wan
- Department of Hematology/Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chao-Chuan Wu
- Department of General Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Superiority of log odds of positive lymph nodes (LODDS) for prognostic prediction after gastric cancer surgery: a multi-institutional analysis of 7620 patients in China. Surg Today 2020; 51:101-110. [PMID: 32754844 DOI: 10.1007/s00595-020-02091-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the 8th pN system with ratio-based and Log odds of positive lymph nodes (LODDS) staging systems for predicting the overall survival (OS) of gastric cancer (GC) patients after curative gastric resection. METHODS We analyzed, retrospectively, clinicopathologic and prognostic data from three Chinese medical centers, on 7620 patients who underwent curative surgery for GC. We established a hypothetical tumor-LODDS-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. The relative discriminative abilities of the different staging systems were assessed using Akaike's Information Criterion (AIC), a linear trend chi-square test, and a likelihood ratio chi-square test. RESULTS The cut-off points of the LODDS were set as: ≤ - 1.5, - 1.5 to - 1.0, - 1.0 to - 0.5, - 0.5 to 0, and > 0. There were significant differences in the survival of patients in different LODDS classifications for each pN or LNR group. When stratified by the LODDS classification, the prognosis was more homologous according to the pN or lymph-node ratio (LNR) classifications. The modified TLM staging system had better discriminatory ability and better optimistic prognostic stratification than the 8th TNM or the TRM staging systems for predicting the prognosis of patients with GC. CONCLUSIONS The LODDS staging system was superior to other lymph-node classifications for predicting the prognosis of patients undergoing gastrectomy GC. LODDS may be incorporated into a GC staging system if these results are confirmed by other studies.
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Amrani Hassani Joutei H, Mahfoud W, Sadaoui I, Fechtali T, Benomar H. [Study of epidemiological clinical and pathological characteristics of gastric adenocarcinoma in a Moroccan population]. Ann Pathol 2020; 40:442-446. [PMID: 32532470 DOI: 10.1016/j.annpat.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
Stomach cancer is essentially represented by gastric adenocarcinomas. It remains one of the world's top ten causes of death with a poor prognosis. The aim of our work is to describe the epidemiological characteristics of gastric adenocarcinoma through a retrospective, observational study over a period of one year. One hundred and twenty one cases were sent to the Pathology Laboratory of the IPM-Casablanca, 98 were selected for this study. There was a male predominance. Patients aged over 50 years represented the predominant age group (62%) (P-value=0.03). The average tumor size was 5,17±2,16cm, and most patients were diagnosed in the advanced TNM stage with a rate of 72.44%. In the absence of specific symptoms, gastric adenocarcinoma is a cancer of elderly, frequently diagnosed at a late stage, minimizing the chances of any curable treatment. The adoption of a screening policy in our area would probably be beneficial. Indeed, the benefit of annual screening at least among people aged over 50 years should be assessed.
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Affiliation(s)
- H Amrani Hassani Joutei
- Laboratoire d'anatomo-histo-pathologie, institut Pasteur-du-Maroc, 1, rue Louis-Pasteur, B.P. 20100 Casablanca, Maroc; Laboratoire de neurosciences pathologies intégrées et substances naturelles, faculté des sciences et techniques, B.P. 650 Mohammedia, Maroc.
| | - W Mahfoud
- Laboratoire d'anatomo-histo-pathologie, institut Pasteur-du-Maroc, 1, rue Louis-Pasteur, B.P. 20100 Casablanca, Maroc; Laboratoire de biologie et santé URAC 34, faculté des sciences Ben'Msik, B.P. 7955 Casablanca, Maroc
| | - I Sadaoui
- Laboratoire d'anatomo-histo-pathologie, institut Pasteur-du-Maroc, 1, rue Louis-Pasteur, B.P. 20100 Casablanca, Maroc; Laboratoire de génétique médicale, faculté de médecine et de pharmacie, B.P. 915 Casablanca, Maroc
| | - T Fechtali
- Laboratoire de neurosciences pathologies intégrées et substances naturelles, faculté des sciences et techniques, B.P. 650 Mohammedia, Maroc
| | - H Benomar
- Laboratoire d'anatomo-histo-pathologie, institut Pasteur-du-Maroc, 1, rue Louis-Pasteur, B.P. 20100 Casablanca, Maroc
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Abdallah EA, Braun AC, Flores BCTCP, Senda L, Urvanegia AC, Calsavara V, Fonseca de Jesus VH, Almeida MFA, Begnami MD, Coimbra FJF, da Costa WL, Nunes DN, Dias-Neto E, Chinen LTD. The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer. Oncologist 2019; 24:e854-e863. [PMID: 30846515 DOI: 10.1634/theoncologist.2018-0741] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gastric adenocarcinoma (GAC) is the third deadliest malignant neoplasm worldwide, mostly because of late disease diagnosis, low chemotherapy response rates, and an overall lack of tumor biology understanding. Therefore, tools for prognosis and prediction of treatment response are needed. Quantification of circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) and their expression of biomarkers has potential clinical relevance. Our aim was to evaluate CTCs and CTM and their expression of HER2 and plakoglobin in patients with nonmetastatic GAC, correlating the findings to clinicopathological data. MATERIALS AND METHODS CTC enrichment was performed with isolation by size of epithelial tumor cells, and the analysis was performed with immunocytochemistry and microscopy. Two collections were made: one at diagnosis (55 samples before neoadjuvant treatment) and one after surgery and before adjuvant therapy (33 samples). RESULTS A high detection rate of CTCs (90%) was observed at baseline. We evaluated HER2 expression in 45/55 biopsy samples and in 42/55 CTC samples, with an overlap of 36 subjects. Besides the good agreement observed for HER2 expression in primary tumors and paired CTCs for 36 cases (69.4%; κ = 0.272), the analysis of HER2 in CTCs showed higher positivity (43%) compared with primary tumors (11%); 3/5 patients with disease progression had HER2-negative primary tumors but HER2-positive CTCs. A significant CTC count drop in follow-up was seen for CTC-HER2-positive cases (4.45 to 1.0 CTCs per mL) compared with CTC-HER2-negative cases (2.6 to 1.0 CTCs per mL). The same was observed for CTC-plakoglobin-positive cases (2.9 to 1.25 CTCs per mL). CONCLUSION CTC analysis, including their levels, plakoglobin, and HER2 expression, appears to be a promising tool in the understanding the biology and prognosis of GAC. IMPLICATIONS FOR PRACTICE The analysis of circulating tumor cell levels from the blood of patients with gastric adenocarcinoma, before and after neoadjuvant treatment, is useful to better understand the behavior of the disease as well as the patients more likely to respond to treatment.
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Affiliation(s)
- Emne A Abdallah
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Alexcia C Braun
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Laís Senda
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Vinicius Calsavara
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | - Felipe J F Coimbra
- Department of Abdominal Surgery - Surgical Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Wilson Luiz da Costa
- Department of Abdominal Surgery - Surgical Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Diana Noronha Nunes
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Emmanuel Dias-Neto
- International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
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Martín Sánchez M, Pérez Escutia MÁ, Lora Pablos D, Guardado Gonzales S, Cabezas Mendoza AM, Campos Bonel A, Pérez Montero H, D’Ambrosi R, Pérez-Regadera Gómez JF. Adjuvant radiochemotherapy in locally advanced gastric cancer. Strahlenther Onkol 2017; 193:1005-1013. [DOI: 10.1007/s00066-017-1173-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/13/2017] [Indexed: 02/07/2023]
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Zhao J, Du F, Zhang Y, Kan J, Dong L, Shen G, Zheng F, Chen H, Zhao J, Ji F, Luo Y, Ma F, Wang Z, Xu B. Impact on long-term survival of the number of lymph nodes resected in patients with pT1N0 gastric cancer after R0 resection: A multicenter study in China. Medicine (Baltimore) 2016; 95:e4420. [PMID: 27495062 PMCID: PMC4979816 DOI: 10.1097/md.0000000000004420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although studies on the association between the number of lymph nodes resected and prognosis in patients with pT2-4N0 stages of gastric cancer have reported consistent results, there is no consensus on the optimal number of lymph nodes to be examined for pT1N0 stage gastric cancer. The aim of this study was to evaluate the long-term effect of the number of lymph nodes removed on the outcomes of patients with pT1N0 stage gastric cancer after R0 resection.From December 2009 to December 2011, 227 patients undergoing R0 resection of pT1N0 stage gastric cancer at 4 Chinese centers were enrolled in this study. Patients were assigned to 2 groups according to the number of lymph nodes dissected (≤15 or > 15). Standard survival methods and restricted multivariable Cox regression models were applied.More women (P = 0.031) were in the ≤15 group than in the >15 group. The mean number of lymph nodes removed from women was greater than that from men (P = 0.007). The 5-year survival rate was significantly higher in the >15 lymph nodes resected group than the ≤15 group. The number of lymph nodes resected was identified as an independent prognostic factor and was significantly correlated with overall survival (OS).A lymphadenectomy with dissection of more than 15 lymph nodes improved the long-term survival of patients with pT1N0 gastric cancer after R0 resection. Therefore, it is necessary to consider removing more than 15 lymph nodes among such patients.
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Affiliation(s)
- Jiuda Zhao
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Feng Du
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | | | - Jie Kan
- People's Hospital of Qinghai Province, Xining, China
| | - Li Dong
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Guoshuang Shen
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Fangchao Zheng
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Hui Chen
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Junhui Zhao
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Faxiang Ji
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Ziyi Wang
- Affiliated Hospital of Qinghai University, High Altitude Medical Research Center
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
- Correspondence: Binghe Xu, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China (e-mail: )
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Kim Y, Park SH, Kim KM, Choi MG, Lee JH, Sohn TS, Bae JM, Kim S, Lee SJ, Kim ST, Lee J, Park JO, Park YS, Lim HY, Kang WK. The Influence of Metastatic Lymph Node Ratio on the Treatment Outcomes in the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) Trial: A Phase III Trial. J Gastric Cancer 2016; 16:105-10. [PMID: 27433396 PMCID: PMC4943998 DOI: 10.5230/jgc.2016.16.2.105] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 12/23/2022] Open
Abstract
Purpose In the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) trial, we investigated whether chemoradiotherapy after D2 gastrectomy reduces the rate of recurrence. Recently, the ratio of metastatic lymph nodes to examined lymph nodes (N ratio) has been proposed as an independent prognostic factor in gastric cancer (GC). The aim of this study was to investigate the relationship between the metastatic N ratio and prognosis of GC after curative D2 surgery. Materials and Methods We retrospectively reviewed the data of 458 ARTIST patients who underwent D2 gastrectomy followed by adjuvant chemotherapy (XP, n=228) or chemoradiotherapy (XPRT, n=230). The disease-free survival (DFS) rates of patients were used to evaluate the influence of N ratio on the treatment outcome. To achieve this, 4 different N ratio categories (0%, 1%~9%, 10%~25%, and >25%) were compared on the basis of their influence on the treatment outcome. Results On multivariate analysis, the N ratio remained an independent prognostic factor for DFS. The hazard ratios (HRs) for the N ratio categories of 0%, 1%~9%, 10%~25%, and >25% were 1, 1.061, 1.202, and 3.571, respectively. In patients having N ratio >25%, the 5-year DFS rates were 55% and 28% for the XPRT and XP arms, respectively (HR, 0.527; 95% confidence interval, 0.307~0.904; P=0.020). Conclusions In patients with curatively resected GC, the N ratio was independently associated with DFS. Although this finding warrants further investigation in future prospective studies, the benefit of chemoradiotherapy for D2 resected GC appears to be more beneficial in cancers having N ratios >25%.
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Affiliation(s)
- Youjin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jin Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Tae Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Oh Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Suk Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Ki Kang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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da Costa WL, Coimbra FJF, Ribeiro HSC, Diniz AL, de Godoy AL, de Farias IC, Begnami MDFS, Soares FA. Total gastrectomy for gastric cancer: an analysis of postoperative and long-term outcomes through time: results of 413 consecutive cases in a single cancer center. Ann Surg Oncol 2014; 22:750-7. [PMID: 25366586 DOI: 10.1245/s10434-014-4212-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Advanced gastric cancer in the upper or middle third of the stomach is routinely treated with a total gastrectomy, albeit in some cases with higher morbidity and mortality. The aim of this study was to describe the morbimortality and survival results in total gastrectomy in a single center. METHODS This retrospective study included patients with gastric adenocarcinoma treated with a total gastrectomy at a single Brazilian cancer center between January 1988 and December 2011. Clinical, surgical, and pathology information were analyzed through time, with three 8-year intervals being established. Prognostic factors for survival were evaluated only among the patients treated with curative intent. RESULTS The study comprised 413 individuals. Most were male and their median age was 59 years. The majority of patients had weight loss and were classified as American Society of Anesthesiologists 2. A curative resection was performed in 336 subjects and a palliative resection was performed in 77 subjects. Overall morbidity was 37.3% and 60-day mortality was 6.5%. Temporal analysis identified more advanced tumors in the first 8-year period along with differences in the surgical procedure, with more limited lymph node dissections. In addition, a significant decrease in mortality was observed, from 13 to 4%. With a median follow-up of 74 months among living patients, median survival was 56 months, and 5-year overall survival was 49.2%. Weight loss, lymphadenectomy, tumor size, and T and N stages were prognostic factors in multivariate analysis. CONCLUSIONS Total gastrectomy is a safe and feasible treatment in experienced hands. Advances in surgical technique and perioperative care have improved outcomes through time.
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Affiliation(s)
- Wilson Luiz da Costa
- Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil,
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Costa Junior WLD, Coimbra FJF, Batista TP, Ribeiro HSDC, Diniz AL. Evaluation of N-ratio in selecting patients for adjuvant chemoradiotherapy after d2-gastrectomy. ARQUIVOS DE GASTROENTEROLOGIA 2014; 50:257-63. [PMID: 24474226 DOI: 10.1590/s0004-28032013000400004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/17/2013] [Indexed: 01/28/2023]
Abstract
CONTEXT Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controversial. OBJECTIVE To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. METHODS A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol) at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. RESULTS Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable) presented "area under ROC curve" (AUC) of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power - AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread - 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150-1.202; P = 0.092). CONCLUSIONS This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%-25%).
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Affiliation(s)
- Wilson Luiz da Costa Junior
- Departamento de Cirurgia Abdominal, Hospital Antônio Cândido de Camargo (A. C. Camargo), São PauloSP, Brasil
| | | | - Thales Paulo Batista
- Departamento de Cirurgia/Oncologia, Faculdade Pernambucana de Saúde, Instituto de Medicina Integral, RecifePE, Brasil
| | | | - Alessandro Landskron Diniz
- Departamento de Cirurgia Abdominal, Hospital Antônio Cândido de Camargo (A. C. Camargo), São PauloSP, Brasil
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11
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Hua YH, Hu QY, Piao YF, Tang Q, Fu ZF. Effect of number and ratio of positive lymph nodes in hypopharyngeal cancer. Head Neck 2014; 37:111-6. [PMID: 24347492 DOI: 10.1002/hed.23574] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 09/09/2013] [Accepted: 12/10/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The number and ratio of positive lymph nodes are important prognostic factors in gastric cancer, but there is little data reported in hypopharyngeal cancer. METHODS Medical data from 81 patients with hypopharyngeal cancer undergoing radical hypopharyngectomy and cervical lymph node dissection were reviewed. RESULTS The median survival time was 84, 54, 30, and 13 months in patients with N0, N1, N2, and N3, respectively, and 84, 51, and 17 months with positive lymph node ratios (N ratio) 0, <10%, and >10%, respectively. Of the 24 N1 patients, the 20 patients that had an N ratio <10% had a better prognosis than the 4 patients with an N ratio >10%. Similar data was seen for the N2 patients. Tumor (T) classification, adjuvant therapy, and N ratio were independent prognostic factors in multivariate analysis. CONCLUSION The positive lymph node ratio is complementary to the current N classification system.
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Affiliation(s)
- Yong-hong Hua
- Head and Neck Cancer Center, Zhejiang Cancer Hospital, Hangzhou, China
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12
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Smith DD, Nelson RA, Schwarz RE. A comparison of five competing lymph node staging schemes in a cohort of resectable gastric cancer patients. Ann Surg Oncol 2013; 21:875-82. [PMID: 24242677 DOI: 10.1245/s10434-013-3356-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND New classifications for lymph node (LN) staging have recently been proposed to improve upon the UICC/AJCC N category staging convention. Ratio-based systems and logarithmic odds (LODDS) scores are two families of novel competing staging systems. We compared UICC/AJCC staging with 5 ratio and LODDS systems in predicting overall survival (OS) in patients with resected gastric cancer. METHODS Using a large population-based dataset, we identified 12,184 nonmetastatic resectable gastric cancer patients between 1988 and 2004. We compared each subject's UICC/AJCC N stage with five novel staging schemes. We analyzed the OS for each method. Our comparison metric was the log-rank Chi squared statistic; larger Chi squared statistics indicate improvements in N stage discrimination. RESULTS Median OS was 2.1 years (95 % CI 2.0-2.2 years), while median patient follow-up for surviving patients was 8.3 years (range, 1 month-22 years). Although all 5 staging systems were either comparable or superior to the UICC/AJCC convention, a LN ratio method outperformed others in N stage discrimination based on log-rank tests for OS. This trend was independent of the number of LNs examined. CONCLUSIONS Novel LN staging methods have a higher degree of discrimination utility than the UICC/AJCC N convention. These methods may have a role in reducing the prognostic impact of LN count variability. Of the systems assessed, the LN ratio system that assigns greater risk attribution to cases with <16 LNs was the best classification method to predict OS in patients with resectable gastric cancer.
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Affiliation(s)
- David D Smith
- Division of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA,
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13
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Nelen SD, van Steenbergen LN, Dassen AE, van der Wurff AAM, Lemmens VEPP, Bosscha K. The lymph node ratio as a prognostic factor for gastric cancer. Acta Oncol 2013; 52:1751-9. [PMID: 23317142 DOI: 10.3109/0284186x.2012.754991] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To predict prognosis of gastric cancer, an adequate assessment of the stage of gastric cancer is important. The UICC/AJCC TNM classification is the most commonly used classification system. For adequate N staging at least 15 lymph nodes should be retrieved. In some countries, this amount of lymph nodes is not met, which can lead to understaging. Therefore, the lymph node ratio (LNR) is proposed as an alternative N staging modality. The purpose of this study was to compare the different staging modalities. Patients and methods. We included all patients who underwent surgery for gastric cancer, newly diagnosed between 2000 and 2009 and staged patient by UICC/AJCC TNM 5th/6th or 7th and by LNR. We conducted crude survival analysis, univariate and multivariate analyses according to the different staging systems. Results. The five-year overall survival rates ranged from 58% for N0 disease to 18% in case of more than 15 metastatic lymph nodes. The distribution of overall five-year survival according to LNR was 58% for LNR0 and 10% for LNR3. Univariate analysis showed that all the UICC/AJCC TNM classification systems as well as the LNR were strong prognostic factors for overall survival. The LNR correlated less with the number of nodes examined. Conclusion. LNR is a good prognostic tool for overall survival, it is an independent prognostic factor with a more homogenous spread of hazard ratios and five-year survival rates than UICC/AJCC systems. Furthermore, the LNR has a lower correlation with the number of nodes examined, making it less vulnerable for stage migration.
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Affiliation(s)
- Stijn D Nelen
- Department of Surgery, Jeroen Bosch Hospital 's-Hertogenbosch , the Netherlands
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14
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Costa WL, Coimbra FJF, Fogaroli RC, Ribeiro HSC, Diniz AL, Begnami MDFL, Mello CAL, Fanelli MF, Silva MJB, Fregnani JH, Montagnini AL. Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center. Radiat Oncol 2012; 7:169. [PMID: 23068190 PMCID: PMC3542168 DOI: 10.1186/1748-717x-7-169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/13/2012] [Indexed: 12/26/2022] Open
Abstract
Background Adjuvant chemoradiotherapy is part of a multimodality treatment approach in order to improve survival outcomes after surgery for gastric cancer. The aims of this study are to describe the results of gastrectomy and adjuvant chemoradiotherapy in patients treated in a single institution, and to identify prognostic factors that could determine which individuals would benefit from this treatment. Methods This retrospective study included patients with pathologically confirmed gastric adenocarcinoma who underwent surgical treatment with curative intent in a single cancer center in Brazil, between 1998 and 2008. Among 327 patients treated in this period, 142 were selected. Exclusion criteria were distant metastatic disease (M1), T1N0 tumors, different multimodality treatments and tumors of the gastric stump. Another 10 individuals were lost to follow-up and there were 3 postoperative deaths. The role of several clinical and pathological variables as prognostic factors was determined. Results D2-lymphadenectomy was performed in 90.8% of the patients, who had 5-year overall and disease-free survival of 58.9% and 55.7%. The interaction of N-category and N-ratio, extended resection and perineural invasion were independent prognostic factors for overall and disease-free survival. Adjuvant chemoradiotherapy was not associated with a significant improvement in survival. Patients with node-positive disease had improved survival with adjuvant chemoradiotherapy, especially when we grouped patients with N1 and N2 tumors and a higher N-ratio. These individuals had worse disease-free (30.3% vs. 48.9%) and overall survival (30.9% vs. 71.4%). Conclusion N-category and N-ratio interaction, perineural invasion and extended resections were prognostic factors for survival in gastric cancer patients treated with D2-lymphadenectomy, but adjuvant chemoradiotherapy was not. There may be some benefit with this treatment in patients with node-positive disease and higher N-ratio.
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Affiliation(s)
- Wilson L Costa
- Department of Abdominal Surgery, Hospital A, C, Camargo, Sao Paulo, Brazil.
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15
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Costa WL, Coimbra FJF, Ribeiro HSC, Diniz AL, de Godoy AL, Begnami M, Silva MJB, Fanelli MF, Mello CAL. Safety and preliminary results of perioperative chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for high-risk gastric cancer patients. World J Surg Oncol 2012; 10:195. [PMID: 22992263 PMCID: PMC3495866 DOI: 10.1186/1477-7819-10-195] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 07/16/2012] [Indexed: 02/08/2023] Open
Abstract
Background Gastric cancer relapse occurs in about 30% of the patients treated with gastrectomy and D2-lymphadenectomy, mainly as distant or peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with an improvement in survival and lower peritoneal recurrence, albeit with increased morbidity. The aim of this study is to report the preliminary results of the association of perioperative chemotherapy, radical surgery and HIPEC in high-risk gastric patients in a single institution. Methods Treatment protocol was started in 2007 and included patients younger than 65 years old, with good performance status and gastric adenocarcinoma with serosa involvement and lymph node metastases, located in the body or antrum. Patients should receive three preoperative cycles of DCF (Docetaxel 75 mg/m2, Cisplatin 75 mg/m2 and continuous intravenous infusion of 5-Fluorouracil 750 mg/m2 for 5 days), followed by gastric resection with D2-lymphadenectomy, hyperthermic intraperitoneal chemotherapy with Mytomicin C 34 mg/m2 and three more postoperative cycles of DCF. Results Ten patients were included between 2007 and 2011. Their median age was 47 years old and six were male. Nine were staged with cT4 cN + tumors and one as cT3 cN+. Nine patients completed all three preoperative chemotherapy cycles. Eight individuals were treated with a total gastrectomy and the other two had a distal gastrectomy, all having HIPEC. Postoperative morbidity was 50%, with no deaths. Regarding postoperative chemotherapy, only 5 patients completed three cycles. With a median follow-up of 25 months, three relapses were identified and 7 patients remain disease-free, two with more than 4 years of follow-up. Conclusion The association of perioperative systemic and intraperitoneal chemotherapy plus radical surgery is a feasible multimodality treatment, with acceptable morbidity. With a longer follow-up and a larger group of patients, we hope to be able to determine if it also influences survival outcomes and patterns of recurrence. Mini-Abstract The association of perioperative chemotherapy, gastric resection and D2-lymphadenectomy and hyperthermic intraperitoneal chemotherapy proved to be associated with acceptable morbidity. For survival analysis, a longer follow-up is needed.
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Affiliation(s)
- Wilson L Costa
- Department of Abdominal Surgery, Hospital A, C, Camargo, Sao Paulo, Brazil.
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Wu ZM, Teng RY, Shen JG, Xie SD, Xu CY, Wang LB. Reduced lymph node harvest after neoadjuvant chemotherapy in gastric cancer. J Int Med Res 2012; 39:2086-95. [PMID: 22289523 DOI: 10.1177/147323001103900604] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This retrospective study investigated the impact of neoadjuvant chemotherapy on the number of lymph nodes harvested in patients with T(3)/T(4) gastric cancer. Lymph node counts in 58 patients who received preoperative neoadjuvant chemotherapy were compared with those in 168 patients who received surgery alone. Significantly more patients (n = 14, 24.1%) treated with neoadjuvant chemotherapy had < 15 lymph nodes harvested compared with patients (n = 13, 7.7%) treated with surgery alone. A significant correlation between the total number of harvested lymph nodes and the number of metastatic lymph nodes (mLNs) existed in both groups. Neoadjuvant chemotherapy was the only factor associated with the retrieval of < 15 lymph nodes. The number of mLNs was an independent predictive factor for overall survival. Although neoadjuvant chemotherapy decreased the number of lymph nodes harvested, the number of mLNs may still be an acceptable prognostic factor in patients with gastric cancer, following neoadjuvant chemotherapy.
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Affiliation(s)
- Z-M Wu
- Department of General Surgery, Shaoxing Hospital, China Medical University, Shaoxing, China
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Petrelli F, Borgonovo K, Barni S. The emerging issue of ratio of metastatic to resected lymph nodes in gastrointestinal cancers: An overview of literature. Eur J Surg Oncol 2011; 37:836-47. [DOI: 10.1016/j.ejso.2011.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 03/25/2011] [Accepted: 07/25/2011] [Indexed: 12/21/2022] Open
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